| NPI | 1740848092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2019-06-02 |